• Issue Brief
  • February 15, 2017

Defining the Role of Children's Hospitals in the Quality Measurement Enterprise

Children's hospitals have an opportunity to focus the measures enterprise on the right measures suitable for pediatric health care. 

The quality measurement enterprise continues to move toward greater cohesion and greater consideration for the development and use of appropriate pediatric metrics. The federal government, allied organizations, states, payers and providers will benefit from collaboration and the harmonization of metrics. CHA continues to explore avenues to promote greater development and dissemination of important and relevant pediatric measures. 

Measures of accountability are, quite simply, those suitable for use in accountability programs. While internal quality improvement (QI) measures may be suitable measures of accountability, they may not always be so. For example, it may be acceptable for a QI measure to be less sensitive and flag false positive, and in fact, this may be a desirable attribute of the measure to alert the clinician or administrator of potential issues with a process. However, measures used for accountability (payment or public reporting) often seek to eliminate false positives. 

In general, measures of accountability are evidence-based, linked to improved outcomes, accurate, and least likely to induce adverse effects. While there are valid measures of child health care and outcomes, the existing measure are not sufficiently capturing and describing critical areas in child health. Thus, we need a focal point around the development and refinement of accountability metrics that can bridge national, state and provider-level.  

Role of national developers and implementers

National measure developers and implementers (e.g., CMS and Agency for Healthcare Research and Quality (AHRQ), National Committee for Quality Assurance (NCQA), the Joint Commission, and measure endorsement entities like the National Quality Forum (NQF) have the opportunity to facilitate the development, refinement, harmonization and endorsement of appropriate adult and pediatric metrics and to void metrics that are not useful. 

Open dialogue with provider and other stakeholders could assist in standardizing a floor of metrics for organizations looking to assess quality performance as a part of their cost equation, and to assist the federal government, states and payers in establishing a worthy set of metrics. Such organizations will play a key role in refining metrics of accountability, which is the focus of CHA's current efforts.

Role of children's hospitals

Children’s hospitals, and hospitals in general, historically have focused quality efforts on internal quality improvement measures. However, as leaders in pediatric care innovation, children’s hospitals are increasingly striving to advance national quality measurement and improvement for children. With unparalleled expertise in pediatric care delivery, children’s hospitals have a critical role to play in the science of pediatric quality measurement, to ensure the appropriateness of measures in children’s care settings and to avoid misapplication of adult-centric measures that may lead to unintended consequences. 

Measure advocacy supports the CHA mission by advancing measures that evaluate, demonstrate, and differentiate children’s hospitals’ critical contribution to innovations in quality, cost, and delivery of care. The vision for CHA measure advocacy seeks to:

  • Influence key public and private sector leaders to establish national pediatric priorities, goals and measures
  • Collaborate with partners to identify and advance meaningful measures
  • Lead measure recommendations that are used as the primary measures in relevant programs

CHA developed a measures selection framework for accountability measures built on the foundation of industry standards, through the perspective of pediatric care providers. 

Children’s hospitals strive to improve the health of all children, with particular expertise in care delivery for children with medical complexity and, more broadly, children with special health care needs or those experiencing an acute event. As community leaders in driving collaborative efforts across care settings to improve health services, children’s hospitals value input from diverse stakeholders and strive to achieve streamlined, consensus evaluation systems.